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Attrition: Stress, Suicide And PTSD
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February 7, 2013: Last year the Israeli armed forces lost 14 troops to suicide. That was a third fewer than in 2011, but more fatalities than the Israelis have suffered in combat over the last four years. The suicide rate is largely driven by stress and Israel has taken the lead in searching for ways to identify and treat this kind of stress. This is all about troops with post-traumatic stress disorder (PTSD) and to what degree they have it. In addition to suicide, Israeli researchers have found that stress (the major cause of PTSD) made troops less vigilant, not, as conventional wisdom long held, more vigilant. A lot of stress tended to make troops zone out, as a way to cope. Some troops did buckle down and become more alert under stress but not the majority. Lack of vigilance in a combat zone is a major source of death, injury, and getting yelled at. It’s long been known the troops who have been in combat often won’t talk about it. Many of these veterans are more often depressed, often to the point of suicide or, more rarely, attacking and killing others.

Since World War II, several other aspects of PTSD have been discovered. Israel noted, after the 1982 war in Lebanon, that reservists were more sensitive to the aftereffects of combat. The Lebanon conflict used a larger (than previous wars) number of older reserve troops, who tended to be more prone to coming down with stress disorders. This was probably due to the fact the full time soldiers are constantly conditioned to deal with stress. While this is often been referred to, often derisively, as "military discipline", it has been known for thousands of years that such practices reduce stress and panic during combat. Apparently it reduces the chances of coming down with stress problems as well. This led to new programs to spot stress related problems as early as possible. This also led to the development of new treatments for these stressors.

Israeli researchers also found markers in the blood that indicated someone has PTSD. This was long suspected but had to wait until techniques and technology capable of detecting such markers was available. Other researchers found that patients suffering from PTSD, along with other forms of mental distress (substance abuse, depression, chronic pain) had different brain images (provided by CT scans) than those with just PTSD. Research is also showing that PTSD is a distinct form of mental distress. For example, research turned up the fact those who had killed someone in combat were 40 percent more likely to show symptoms of PTSD or similar symptoms found in those who suffered concussions from roadside bombs.

Many troops, because of exposure to roadside bombs and battlefield explosions in general, have developed minor concussions that, like sports injuries, can turn into long term medical problems. Often these concussions were accompanied by some PTSD. Further research documented the connection between concussions, and other brain trauma, and some forms of PTSD.

There is a PTSD epidemic right now, created by (for the Americans) the unprecedented exposure of so many troops to so much combat in so short a time. For the Israelis PTSD is caused by thousands of reservists being called up each year for security duty. There they have to deal with particularly stressful encounters with Arabs or nervous Israeli civilians. But what is actually happening is the discovery that much of what is thought to be PTSD is actually physical injuries (to the brain) that can now be detected (with more precise instruments like MRI and blood tests) and often treated. Thus it is becoming clear that there are several different conditions here, all with similar PTSD symptoms but not with similar effects on the brain. Each strain of PTSD will require a different type of cure. Finding these cures is increasingly important, since better diagnostic capabilities has made it possible to more frequently, and accurately, diagnose PTSD.

None of these discoveries is going to cure PTSD but they are examples of how new technology (how to easily measure neurosteroids in the brain and cheaper and easier brain scans) has made it possible to isolate the physical factors operating in PTSD patients. That kind of incremental success results in better treatments for PTSD. Success in this endeavor can be measured, in part, by reductions in the suicide rate among troops.

PTSD has been around for as long as humans have been exposed to terrifying situations. But only in the past few decades has there been a lot of scientific research on the subject. It is now known that about twelve percent of people exposed to a traumatic situation (combat, car crash, whatever) will eventually develop psychological problems (can't sleep or concentrate, plus irritability, nightmares, and flashbacks) months after the trauma. Until the development of tests that accurately identified those most likely to develop PTSD you had to watch everyone if you wanted to identify the PTSD victims. The new blood test will make it easier to treat PTSD victims, who can, in most cases, have their PTSD cured or minimized if they get the right treatment quickly enough.

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